Inspection on 30/08/05 for Clifftop

This inspection was carried out on 30th August 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Clifftop 02/08/07

Clifftop 03/10/06

Clifftop 20/03/06

Clifftop 16/02/05

Clifftop 22/06/04

Clifftop 04/03/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Clifftop 8 Burlington Road Swanage Dorset BH19 1LS Lead Inspector Amanda Porter Unannounced 30 August 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Clifftop D55 S26784 Clifftop V236404 300805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Clifftop Address 8 Burlington Road, Swanage, Dorset, BH19 1LS Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01929 422091 01929 424299 Mrs Christine Harrison Mrs Patricia Pride PC Care Home only 32 Category(ies) of OP - 32 registration, with number of places Clifftop D55 S26784 Clifftop V236404 300805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Room Nos. 2 and 3 may be used as doubles. Date of last inspection 16 February 2005 Brief Description of the Service: Clifftop Care Home is a large detached Edwardian property set in its own grounds, overlooking the sea, on a prominent cliff top position in a quiet residential area of Swanage. It is in close proximity to the town and local amenities. The home has been registered to Mrs Christine Harrison since 1996 and is personally run by her, together with the registered manager Mrs Trish Pride. Clifftop is registered to accommodate a maximum of thirty-two elderly persons in twenty-eight single rooms and two double rooms. All rooms are en-suite and there is a passenger lift available to all floors. The home caters for residents with varying general needs related to old age, but does not provide nursing care other than that which can be met by the District Nursing Service. There are attractive views of Swanage Bay from the communal lounges and some of the bedrooms. Clifftop D55 S26784 Clifftop V236404 300805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place during the day of the 30th August 2005 and took two inspectors four hours each. The purpose of the inspection was to review the requirements and recommendations made in the last report and to assess key standards. The deputy manager was on hand throughout to aid the inspection process. Five residents, one visitor and five members of staff were spoken with and asked their views on the services provided at Clifftop. Some documentation was reviewed, including care files, personnel files, training records, policies and procedures. A tour of the premises was undertaken. What the service does well: Residents spoke favourably of the staff ‘Splendid’, ’Staff very good’, and ‘Staff excellent very kind to residents’. Service users also felt staff treated them with respect and responded quickly if they needed help. One resident commented upon the improvement that had occurred in staffing now the home was employing some staff from overseas. He/she felt this had provided more continuity of care for residents as staff are employed on a two year contract. Residents said they were happy at “Clifftop – It’s my home” “I’m happy here.” A visitor confirmed that she was made welcome at the home and could call at any time and would be provided with refreshments, this view was also confirmed in discussion with residents. The home ensures access to health care services to meet assessed needs and liaises with a variety of health care professionals. Clifftop cater for dietary needs very well. The menu offers choice and residents say they enjoy the food provided. Meals can be taken wherever the resident chooses but most people opt to eat in the dining room for most meals. The complaints procedures reassure residents that their views are important to the home and that any complaints they raise will be properly investigated. Sufficient numbers of staff are on duty throughout the day and night to be able to meet the needs of the residents. Clifftop D55 S26784 Clifftop V236404 300805 Stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? What they could do better: As a result of this inspection six requirements and five recommendations have been made. A full assessment of needs must be undertaken prior to any resident being admitted to the home so that staff can assure the resident their needs can be met. Further work needs to be done to make sure care plans give details of how residents’ needs are to be met. Residents and their chosen representatives must be invited to participate in the drawing up and review of plans of care that affect them and their views must be considered. Care plans need to reflect all aspects of the residents health and welfare. Service users receive their medicines as prescribed but the home needs to improve procedures for recording receipt of medicines to protect service users. The home’s medication policy needs to give clear information about selfmedication. Staff, who administer medication, need to receive accredited training on this subject. Procedures for responding to suspicions of abuse must be revised in accordance with the corresponding requirement that has been made (see requirement 4), so that they are in line with Department of Health guidance and this will ensure that any allegations of abuse will be managed effectively. Foundation training should be completed within the first six months of employment. This would ensure residents could be confident that staff are trained and competent to do their jobs. Two residents commented upon varied heating in the communal lounge and dining area and said that in the winter the heating could be inadequate as Clifftop D55 S26784 Clifftop V236404 300805 Stage 4.doc Version 1.40 Page 7 “Staff are busy and kept warm but it does not occur to them that we might not be.” To ensure that any risk to the residents and staff are kept to a minimum the recommendations made by Dorset Fire and Rescue Service should be met and fire safety regulations adhered to. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Clifftop D55 S26784 Clifftop V236404 300805 Stage 4.doc Version 1.40 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Clifftop D55 S26784 Clifftop V236404 300805 Stage 4.doc Version 1.40 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2 & 3. Standard 6 is not applicable as the home does not provide intermediate care. Each resident is issued with detailed terms and conditions/contracts. The admissions process is inconsistent and does not always enable the home to thoroughly assess a persons needs or establish whether those needs can be met at Clifftop although where able, residents can visit the home prior to moving in on a trial basis. EVIDENCE: Files seen held evidence that residents had been issued with a contract, which contained details of terms and conditions of residency and this included: • Rooms to be occupied • Overall care and services • Fees payable. Four care files were seen and each had information gained through a preadmission assessment. The quality of the information obtained was variable. Some assessments were very thorough and contained sufficient information on which to base a care plan. Others did not contain such information and had Clifftop D55 S26784 Clifftop V236404 300805 Stage 4.doc Version 1.40 Page 10 been reliant only on information gained from a family member via a telephone call. This course of action could result in the home admitting someone whose needs could not be fully met by staff at Clifftop. Residents were given written assurance that their needs could be met. Clifftop D55 S26784 Clifftop V236404 300805 Stage 4.doc Version 1.40 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 &10 The care planning system in place is not sufficiently clear or consistent to adequately provide staff with the information they need to satisfactorily meet resident’s needs. However the health needs of residents are well met with evidence of good support from community professionals such as GPs, district nurses, speech therapist, community psychiatric nurses, opticians and dentists. Service users receive their medicines as prescribed but the home needs to improve procedures for recording medicines and training staff to protect service users. Residents felt that staff were kind and caring, treated them with respect and upheld their right to privacy. EVIDENCE: Four care files were reviewed and each contained care plans and general risk assessments. Where the risk of developing a pressure sore was high action was taken and the district nurse provided the equipment necessary for the promotion of tissue viability and prevention or treatment of pressure sores. Clifftop D55 S26784 Clifftop V236404 300805 Stage 4.doc Version 1.40 Page 12 Visits from GP, district nurse, community psychiatric nurse, speech therapist, dentist and optician were recorded in the residents care file. Residents said that their healthcare needs were met, one resident had recently had a hearing test, and another person confirmed that there was a visiting optician, although he/she retained independence by going into town to see the optician individually. There is also a visiting chiropodist and exercise classes on a regular basis. Care plans gave general rather than specific instructions to care staff as to how needs were to be met and did not fully reflect the care needed by each individual. Some instruction was included in the care plan and other information was included in the daily records, which meant that to gain a fuller picture of the resident’s needs all of these documents would have to read, which was time consuming. One file revealed that a resident had a pressure sore but there was no care plan relating to this. Others highlighted a need in relation to social activities but did not give clear instruction as to how these needs would be met. There was no evidence that either the resident or their chosen representative had been invited to give their views about the plan of care. However care staff evaluated the care plans monthly. Records of the receipt of medicines were incomplete. However examination of records indicated that medicines are properly administered in accordance with the prescriber’s instructions. The home has a medicines policy and procedure including reference to the arrangements for ordering, administration and disposal. It did not contain instruction about residents who wish to self medicate although the home did accommodate a resident who did this and the appropriate risk assessment had been undertaken. Medicines were stored in a locked trolley and those needing refrigeration were held in a locked box in the kitchen fridge. Residents confirmed that they were treated with respect and kindness and their right to privacy was upheld. Two staff recruited from overseas were seen, who are administering medication. They had received one training session from the local chemist, but have not yet received accredited training. Clifftop D55 S26784 Clifftop V236404 300805 Stage 4.doc Version 1.40 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 15. Dietary needs of residents are well catered for with a balanced and varied selection of food available that meets residents’ tastes and choices. EVIDENCE: The home employs an experienced chef who works from 9.00 –13.30 and is responsible for preparing the main meal that is served at 12.30. He also leaves some prepared food for tea, served at 18.00 hours, depending upon the menu for the day. Currently the home caters for six diabetic residents and meals are adapted to suit their needs. Residents were generally satisfied with the food provided and confirmed they had a choice. Breakfast is served in residents’ rooms preceded by an early morning drink at 6.30 if required. One resident said “efforts are made to suit individual needs, but the menu can be unimaginative.” He/she also said one resident who had now left liked to have egg and bacon daily for breakfast and “She got I”. Another resident commented “ Food very good, more than enough”.’ A bowl of fruit and a plentiful supply of sweets are available for residents to help themselves. There is a four-week menu and a selection of menus were seen during the inspection. Clifftop D55 S26784 Clifftop V236404 300805 Stage 4.doc Version 1.40 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 & 18. A written complaints procedure leaves residents and relatives in no doubt that steps will be taken to deal with any complaint or concern they may have. Procedures for responding to suspicions of abuse are not held in accordance with Department of Health guidance therefore any allegations of abuse cannot be managed effectively. EVIDENCE: The complaints procedure is displayed on a wall near the dining room and includes who to contact. Three permanent residents expressed their views about what they would do if they wished to complain. One person said he/she would “Put up with it” whilst two others would seek out the manager, one resident commented “Trish is ready to listen, you can talk things over with her.” Clifftop has a policy available to staff which deals with the action required in responding to suspicion or evidence of abuse. This policy did not make clear that in the event of any allegation being made staff must consult with the local Dorset Social Care and Health agency and refer to the “No Secrets” guidance provided by that agency. Clifftop D55 S26784 Clifftop V236404 300805 Stage 4.doc Version 1.40 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 & 26. Generally the standard of the environment with Clifftop is good providing residents with an attractive and homely place to live. The home is clean and free from unpleasant odours, however the laundry facilities could be improved. EVIDENCE: The home has a programme of routine maintenance, which is followed. Generally the décor was in good order and the facilities are safe. However two residents commented upon varied heating in the communal lounge and dining area and said “in the winter the heating could be inadequate as staff are busy and keep warm but it does not occur to them that we might not be.” The gardens at the rear of the property are attractive and easily accessible to all residents. The Environmental Health Officer had visited the home in June 2005 and the premises were satisfactory. One requirement was made that soap and hygienic hand drying facilities must be provided in the kitchen and evidence was seen that the home had now complied with this. Clifftop D55 S26784 Clifftop V236404 300805 Stage 4.doc Version 1.40 Page 16 The laundry is well managed by a designated member of staff. The Registered Provider stated “We have 3 washing machines all clearly visible next to each other. One machine for the sole use of continence problems. We also use Ariel Hygiene which washes at 40c. This is a special product recommended by the health authority as it kills all know germs including MRSA thus avoiding cross infection this does away with need for a sluice.” Clifftop D55 S26784 Clifftop V236404 300805 Stage 4.doc Version 1.40 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 & 30. The deployment and number of staff is sufficient to meet the needs of the residents. Recruitment and employment practices are designed to minimise the risk of unsuitable staff being employed. Some shortfalls in the training may result in some care staff not being fully competent to do their jobs properly and therefore residents could not be assured they were in safe hands at all times. EVIDENCE: Two weeks of duty rotas were seen during the inspection and they showed that sufficient numbers of staff were employed to meet the needs of the residents. Four • • • • • • • • staff files were seen. Each contained: A completed application form Appraisals Offer of employment letter Work permits where necessary Contract of employment Two written references Documentary evidence of any relevant qualifications CRB check. The training records for four members of staff were seen and training was Clifftop D55 S26784 Clifftop V236404 300805 Stage 4.doc Version 1.40 Page 18 discussed with staff. All staff spoken with were enthusiastic about training and said that they enjoyed the training opportunities provided and found them valuable for the work they undertook. There was evidence that staff undertook induction training but some files did not contain evidence that foundation training was completed within the first six months of employment. The Registered Provider has asserted that staff have completed this training but that staff had their work books at home. A reminder is provided that copies of such records should be kept at the home and available for inspection at all times. This standard will be re-checked at the next inspection. Clifftop D55 S26784 Clifftop V236404 300805 Stage 4.doc Version 1.40 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38. The home is unable to demonstrate that residents and staff are fully protected until there is full compliance with the recommendations made by Dorset Fire and Rescue Service. EVIDENCE: Standard 37 was not fully assessed during this inspection. However the home is now reporting any untoward events at the home to the Commission for Social Care Inspection as required under regulation 37 of the Care Homes Regulations 2001. Records showed that all staff had received recent training in fire safety, food hygiene, infection control and manual handling. Staff spoken with confirmed this. Substances hazardous to health were seen to be stored securely. Clifftop D55 S26784 Clifftop V236404 300805 Stage 4.doc Version 1.40 Page 20 Following an inspection of the home by Dorset Fire and Rescue Service in October 2004 a report was submitted by the fire officer, which highlighted some recommendations that should be met so that the home fully complies with fire safety regulations. Four of the seven recommendations have been met and work is scheduled to take place in September 2005 so the remaining three are met. The door between the kitchen and dining room does not shut properly. Advice needs to be obtained from the Dorset Fire and Rescue Service regarding the best way to remedy this. Clifftop D55 S26784 Clifftop V236404 300805 Stage 4.doc Version 1.40 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 3 2 x x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 3 COMPLAINTS AND PROTECTION 2 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 1 x x x x x x x 1 Clifftop D55 S26784 Clifftop V236404 300805 Stage 4.doc Version 1.40 Page 22 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(1) & (2) Requirement The registered manager must ensure that care plans are drawn up with the involvement of the resident, recorded in a style accessible to the resident; agreed and signed by the resident whenever capable and/or representative (if any). The registered manager must ensure that care plans set out in detail the action which needs to be taken by care staff to ensure that all aspects of the health, personal and social care needs of the residents are met. The homes policy relating to adult protection must inform the reader to consult with an officer of the local Dorset Social Care and Health agency in the event of an allegation of abuse and must refer him/her to the No Secrets guidance provided by that agency. Advice must be sought from the Dorset Fire and Rescue Service about a suitable fire closing device to esnure the door between the kitchen and the dining room closes properly. The recommended actions of the Timescale for action 30/11/05 2. OP7 15(1) 30/11/05 3. OP18 12(1) 30/11/05 4. OP38 23(4) 30/11/05 5. Clifftop OP38 23(4) 30/11/05 Page 23 D55 S26784 Clifftop V236404 300805 Stage 4.doc Version 1.40 fire service (reference DFRS letter dated 28/10/04) must be implimented in order to ensure adequate precautions against the risk of fire. (This requirement was first made in the report 16/02/05). 6. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP3 Good Practice Recommendations The standard of pre-admission assessment should be consistent and each one should include detailed information on the prospective residents state of health and wellbeing. The home should keep records of all medicines received into the home. The medication policy should include information about self administration of medication. It is strongly recommended that all staff administering medication should have completed accredited training on this topic. Care staff should receive foundation training to National Training Organisation specification within the first six months of appointment. 2. 3. 4. 5. OP9 OP9 OP9 OP30 Clifftop D55 S26784 Clifftop V236404 300805 Stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection Unit 4, New Fields Business Park Stinsford Road Dorset BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Clifftop D55 S26784 Clifftop V236404 300805 Stage 4.doc Version 1.40 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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